Remote Therapy for Alcohol and Dating Aggression in Non-College Emerging Adults.

Summary

This training and research plan will prepare Dr. Epstein-Ngo, an interdisciplinary, fellowship-trained, clinical psychologist, to become an independent clinical researcher.

Abstract

This training and research plan will prepare Dr. Epstein-Ngo, an interdisciplinary, fellowship-trained, clinical psychologist, to become an independent clinician-researcher. She will receive the training necessary to develop expertise in technology-enhanced alcohol use and dating aggression (DA; physical, verbal, and digital) interventions for high-risk emerging adults in non-college settings. A major concomitant problem of alcohol misuse is DA. Both risk behaviors are common, significant, and interrelated causes of psychological distress, injury, and mortality among high-risk, urban emerging adults. Alcohol is consistently linked with aggression in psycho-social research and laboratory studies. Rates of alcohol misuse increase dramatically and peak during emerging adulthood (18-25 years), and Healthy People 2020 identified dating violence as a serious concern growing among youth. Furthermore, poverty, violence, and health disparities disproportionately affect emerging adults not enrolled in college, yet this population is rarely studied. Currently research and intervention on alcohol misuse and DA have focused on students in college settings. High-risk emerging adults often drop out of school and do not have a source of primary medical care, making the emergency department (ED) a unique place to access these youth to initiate alcohol and DA interventions. Emerging adults, in particular, could benefit from targeted interventions for alcoho misuse and severe or frequent DA in order to change the trajectory of negative health consequences associated with these two risk behaviors. Although a few technology-enhanced brief interventions have focused on substance use and peer violence, there have been no interventions targeting co-occurring alcohol misuse and DA, particularly from ED settings. Moreover, more intensive therapeutic approaches may be needed for multiple co-occurring risk behaviors. Innovative research is needed to develop an intervention addressing both alcohol misuse and DA, with particular attention to utilizing the full capabilities of new technologies in order to increase delivery of much-needed services to difficult to reach high-risk emerging adults who are not enrolled in college. During the course of this proposed career development award, Dr. Epstein-Ngo will develop and pilot test a targeted 8-session psychotherapeutic intervention to reduce alcohol misuse and associated DA and mental health problems with high-risk emerging adults seeking emergency medical care, that will be delivered by a remotely-located therapist via smartphone or other smart technology. The intervention will incorporate Cognitive-Behavioral approaches with Motivational Interviewing and Mindfulness strategies. With the guidance of her dedicated mentorship team of NIH-funded researchers, Dr. Epstein-Ngo will achieve three training goals: 1) Learn techniques for therapy protocol and manual development and evaluating intervention fidelity; 2) Acquire the skills necessary to incorporate technology int a psychotherapy intervention for high-risk emerging adults in non-college settings; and 3) Acquire the skills necessary to design, conduct, and obtain funding for a clinical trial of an ED-based alcohol misuse and DA intervention. Dr. Epstein-Ngo’s training activities will be closely aligned with an innovative research plan allowing for the practical application of her new skills. Dr. Epstein-Ngo will: 1) Develop a remote therapy intervention to reduce alcohol misuse (Audit-Ce4) and severe or frequent DA among high-risk, urban, emerging adults in non-college settings; 2) Refine intervention content, therapist training protocol, therapy manual, and fidelity assessment; and 3) Conduct a pilot randomized control trial (n=30) of the remote therapy compared to enhanced usual care (i.e., educational materials, referrals). This work will facilitate Dr. Epstein-Ngo’s long-term research goal of becoming an independent investigator, developing effective interventions addressing alcohol misuse and aggression for high-risk urban youth using feasible, cost-effective, and easily implemented technology-enhanced interventions. Development of an efficacious intervention delivered via smartphones is innovative and has tremendous potential for future translation for ED settings for high-risk emerging adults with alcohol misuse and DA. Given the public health costs associated with alcohol misuse and DA during this critical developmental period, including increased risk for mental health problems and injury, the proposed intervention is timely, significant, and crucial to reduce health disparities among high-risk, vulnerable emerging adults from non-college settings.